Christina Patterson: The painful truth is that we have too many hospitals

If you're very fat or have diabetes or dementia, what you need is GPs and support workers


Aneurin Bevan wouldn't be too thrilled. Aneurin Bevan might, in fact, if he was still alive, which, luckily for his peace of mind, he isn't, be rather cross. He might be really quite irritated that, 64 years after he launched a national health service, to last "as long as there are folk left with the faith to fight for it", three south London hospitals might, for the first time ever, through lack of money, have to close.

He might be surprised to hear that the organisation that ran the hospitals, which was called a "trust", but not in the sense that you could trust it, was about to go bankrupt. He might be even more surprised to hear that 20 more were in such a financial mess that they might, too. He might wonder how organisations that were funded by the public purse, in a healthcare system a government had promised not to cut, could go bankrupt. He might think "bankrupt" was the kind of word you used about a business, and that treating people who were very ill, and couldn't pay for it, except through their taxes, wasn't usually the kind of thing that made a profit.

And he might be surprised that the reason the South London Healthcare Trust, and Ealing Hospitals Trust, and Surrey and Sussex Healthcare Trust, and lots of other trusts around the country were in very, very big trouble was because they had borrowed money to build very smart buildings in something called a "private finance initiative". He might understand that you have to spend money to make people better. He did, after all, manage to get doctors to agree to an NHS by "stuffing their mouths with gold", which other Labour governments thought you had to do, too. But he might well be surprised to hear that some NHS trusts are paying £60m a year on loans for buildings that are much, much bigger than they're worth.

He might, for example, be surprised to hear that buildings worth £11.4bn will (if you include some costs for cleaning and maintenance) cost the taxpayer £70bn. He might be a little bit shocked to hear that the taxpayer sometimes pays contractors £75 for an air freshener, and £466 to change a light fitting and £15,000 to hang a door. He might wonder why people who were responsible to taxpayers signed contracts where private companies made all the profit and the public took all the risk.

He might not be so surprised to discover that the scheme was originally introduced by a Tory government, but he might well be surprised to hear that it continued under a Labour one, and that most of the contracts that were threatening to bankrupt these trusts were signed with that Labour government's blessing.

But if he had heard the Today programme yesterday, which, luckily for him he didn't, because it can put you in quite a bad mood, he might have been surprised to hear everyone who talked about the South London Healthcare Trust sounding quite cheerful. Chris Streather, for example, the chief executive of the trust, said that going into administration would offer an opportunity to "collaborate with other people in the NHS" and "get the whole health economy of South East London together to reduce costs".

And Chris Ham, the chief executive of the health think-tank the Kings Fund, sounded quite cheerful when he said that the "challenge of the administrators" would be to "make sure patients continue to get access to the services they want", but "within the funding envelope". He didn't say what a "funding envelope" was, or why, if you were a chief executive, you had to be called Chris. But he did say that having an administrator to sort out a financial mess would be "very convenient". It would, he said, "distance politicians from the decisions that are being made". It would also, he said, be an opportunity to "face up to problems we've known about for a long time".

Even Stephen Dorrell, who has been a health secretary, and is now chair of the health select committee, sounded quite cheerful. Most of us, if we were involved with health, and were a member of the party that had just done its very best to dismantle the NHS, with a 476-page programme of reform that nobody outside the Government voted for, wouldn't. Most of us would think that to spend millions and millions and millions on a very complicated restructuring that nobody seems to understand, which involved people on very big salaries being given very big pay-offs and then being instantly reemployed with a different job title, wasn't a very good idea. We might, for example, have read the report by the Faculty of Public Health, which said that the reforms would "increase the amount of money spent on administering the system" and "disadvantage" the people who "already suffer the worst health outcomes".

But Stephen Dorrell sounded as if he was having a lovely time. He didn't really mention the reforms, which you can sort of understand, but he did say that "there needs to be a shift away from over-dependence on hospitals into improved services in the community that prevent some cases needing to go to hospital in the first place".

And he's right. Of course, he's right. Everybody knows he's right. Doctors know he's right. Politicians know he's right. Everyone seems to agree that the answer to the health problems we're all facing isn't lots and lots of hospitals. If you're very fat, or have diabetes, or dementia, or are just very old, going to hospital won't really help you. If you're very fat, or have diabetes, or dementia, or another condition that won't go away, what you need is "community matrons" and GPs, and support workers, and clinics that do their very best to keep you healthy and fit at home.

Politicians know this, but they don't dare say. They don't want to be the one to close their local hospital. They don't want to be the one to say that budgets aren't bottomless and that health is often linked to choices you make in your lifestyle. The Tory ones even seem to think that the state that picks up the bill for poor health shouldn't try to regulate the industries that make people ill. They seem to think that the freedom of corporations to sell their products to sometimes desperate people matters more than the freedom of those people to be well.

Aneurin Bevan might, it's true, not have been all that surprised. Politics, he said, is not "the arena of morals", but the "arena of interest". And it's in politicians' interests to pretend that a hospital on every doorstep is the answer to the demographic time-bombs we're all so keen to ignore. But he might have noted that to waste millions on changes no one wants or needs, and duck the reforms you really need to make, won't help taxpayers, won't help patients, and sure as hell won't help politicians.;

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